Complications
Left atrial enlargement and increased age commonly cause atrial fibrillation in patients with mitral stenosis. Treatment involves correction of the abnormal rate/rhythm, along with anticoagulation.
The yearly risk of thromboembolism, often causing stroke, may be as high as 15% in the patient with mitral stenosis and atrial fibrillation.[45][46][47]
The combination of flow stasis caused by the stenotic valve and loss of mechanical propulsion from a fibrillating left atrium leads to thrombus formation, potential embolisation, and stroke.
If embolisation occurs despite adequate anticoagulation with warfarin, aspirin can be added to the regimen.[48]
Although the role of mechanical relief of mitral obstruction in preventing subsequent stroke is unknown, many would advocate mechanical therapy once the stroke patient is stable.
If bleeding occurs while the patient's INR is in the recommended 2.5 to 3.5 range, the bleeding source should be sought and treated directly.
If bleeding occurs while the patient is over-anticoagulated, the warfarin should be reversed by administration of vitamin K and fresh frozen plasma while the source of the bleeding is sought and treated.
Although all damaged valves have the potential to become infected, infective endocarditis in mitral stenosis is relatively rare.
Once it is identified, standard antibiotic therapy for 4 to 6 weeks is the usual therapy.[49]
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